California Licensed Medical Reviewer

Job Summary

Providing subject-matter expertise in a remote full-time capacity, the California Licensed Medical Reviewer will evaluate durable medical equipment claims, Treatment Authorization Requests (TARs), and supporting documentation to ensure compliance with medical necessity and program requirements.

Key responsibilities

• Review DME-related claims, TARs, prescriptions, and supporting medical documentation
• Evaluate requests for durable medical equipment based on medical policies and coverage requirements
• Document review findings and collaborate with clinical and operational teams to support claim adjudication

Required qualifications

• Minimum of three (3) years of professional experience with Durable Medical Equipment (DME)
• Strong knowledge of DME products, equipment, supplies, and their uses
• Experience managing a DME business or understanding healthcare billing preferred
• Ability to interpret medical documentation, prescriptions, and claims
• Proficiency in navigating multiple computer systems and applications for review processes